Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial

Troels Lunn; Billy Bjarne Kristensen; Lasse Andersen; H Husted; K S Otte; L Gaarn-Larsen; H Kehlet; Niels Kristian Stahl Otte; Henrik Kehlet

doi:http://dx.doi.org/10.1093/bja/aeq333

Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial

Troels Lunn, Billy Bjarne Kristensen, Lasse Andersen, H Husted, K S Otte, L Gaarn-Larsen, H Kehlet, Niels Kristian Stahl Otte, Henrik Kehlet

162 Citations (Scopus)

Abstract

Background: Total knee arthroplasty (TKA) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied.MethodsForty-eight patients undergoing unilateral TKA were included in a randomized, double-blind, placebo-controlled trial receiving preoperative methylprednisolone (MP) 125 mg i.v. or saline. All surgery was performed under lumbar spinal anaesthesia and patients received a standardized, multimodal analgesic regime. The primary endpoint was pain during walking 24 h after surgery, and secondary endpoints were pain at rest, pain upon hip flexion, and pain upon knee flexion. Pain assessments were performed repeatedly for the first 48 h after surgery, in a questionnaire from days 2 to 10, and at follow-up on days 21 and 30. Tertiary endpoints were postoperative nausea and vomiting (PONV), plasma C-reactive protein (CRP) concentrations, fatigue, sleep quality, and rescue analgesic and antiemetic requirements.ResultsPain during walking was significantly lower in the MP group up to 32 h after operation. Overall pain and cumulative pain scores (248 h) were lower for all pain assessments (P<0.04). Consumption of rescue oxycodone was lower from 0 to 24 h (P0.02) and PONV, consumption of ondansetron reduced (P<0.05), and CRP concentrations were lower at 24 h (P<0.000001). Fatigue throughout the day of surgery was lower (P0.02), but sleep quality was worse on the first night (P0.002). No side-effects or complications were observed in other respects.ConclusionsMP 125 mg before surgery improves analgesia and immediate recovery after TKA, even when combined with a multimodal analgesic regime. These findings call for further studies on safety aspects.

Original language	English
Journal	British Journal of Anaesthesia
Volume	106
Issue number	2
Pages (from-to)	230-8
Number of pages	8
ISSN	0007-0912
DOIs	https://doi.org/10.1093/bja/aeq333
Publication status	Published - Feb 2011

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title = "Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial",

abstract = "Background: Total knee arthroplasty (TKA) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied.MethodsForty-eight patients undergoing unilateral TKA were included in a randomized, double-blind, placebo-controlled trial receiving preoperative methylprednisolone (MP) 125 mg i.v. or saline. All surgery was performed under lumbar spinal anaesthesia and patients received a standardized, multimodal analgesic regime. The primary endpoint was pain during walking 24 h after surgery, and secondary endpoints were pain at rest, pain upon hip flexion, and pain upon knee flexion. Pain assessments were performed repeatedly for the first 48 h after surgery, in a questionnaire from days 2 to 10, and at follow-up on days 21 and 30. Tertiary endpoints were postoperative nausea and vomiting (PONV), plasma C-reactive protein (CRP) concentrations, fatigue, sleep quality, and rescue analgesic and antiemetic requirements.ResultsPain during walking was significantly lower in the MP group up to 32 h after operation. Overall pain and cumulative pain scores (248 h) were lower for all pain assessments (P<0.04). Consumption of rescue oxycodone was lower from 0 to 24 h (P0.02) and PONV, consumption of ondansetron reduced (P<0.05), and CRP concentrations were lower at 24 h (P<0.000001). Fatigue throughout the day of surgery was lower (P0.02), but sleep quality was worse on the first night (P0.002). No side-effects or complications were observed in other respects.ConclusionsMP 125 mg before surgery improves analgesia and immediate recovery after TKA, even when combined with a multimodal analgesic regime. These findings call for further studies on safety aspects.",

author = "Troels Lunn and Kristensen, {Billy Bjarne} and Lasse Andersen and H Husted and Otte, {K S} and L Gaarn-Larsen and H Kehlet and Otte, {Niels Kristian Stahl} and Henrik Kehlet",

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T1 - Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial

AU - Lunn, Troels

AU - Kristensen, Billy Bjarne

AU - Andersen, Lasse

AU - Husted, H

AU - Otte, K S

AU - Gaarn-Larsen, L

AU - Kehlet, H

AU - Otte, Niels Kristian Stahl

AU - Kehlet, Henrik

PY - 2011/2

Y1 - 2011/2

N2 - Background: Total knee arthroplasty (TKA) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied.MethodsForty-eight patients undergoing unilateral TKA were included in a randomized, double-blind, placebo-controlled trial receiving preoperative methylprednisolone (MP) 125 mg i.v. or saline. All surgery was performed under lumbar spinal anaesthesia and patients received a standardized, multimodal analgesic regime. The primary endpoint was pain during walking 24 h after surgery, and secondary endpoints were pain at rest, pain upon hip flexion, and pain upon knee flexion. Pain assessments were performed repeatedly for the first 48 h after surgery, in a questionnaire from days 2 to 10, and at follow-up on days 21 and 30. Tertiary endpoints were postoperative nausea and vomiting (PONV), plasma C-reactive protein (CRP) concentrations, fatigue, sleep quality, and rescue analgesic and antiemetic requirements.ResultsPain during walking was significantly lower in the MP group up to 32 h after operation. Overall pain and cumulative pain scores (248 h) were lower for all pain assessments (P<0.04). Consumption of rescue oxycodone was lower from 0 to 24 h (P0.02) and PONV, consumption of ondansetron reduced (P<0.05), and CRP concentrations were lower at 24 h (P<0.000001). Fatigue throughout the day of surgery was lower (P0.02), but sleep quality was worse on the first night (P0.002). No side-effects or complications were observed in other respects.ConclusionsMP 125 mg before surgery improves analgesia and immediate recovery after TKA, even when combined with a multimodal analgesic regime. These findings call for further studies on safety aspects.

AB - Background: Total knee arthroplasty (TKA) is associated with severe pain and inflammation despite an extensive multimodal analgesic approach, but the effect of high-dose glucocorticoid administration has not been studied.MethodsForty-eight patients undergoing unilateral TKA were included in a randomized, double-blind, placebo-controlled trial receiving preoperative methylprednisolone (MP) 125 mg i.v. or saline. All surgery was performed under lumbar spinal anaesthesia and patients received a standardized, multimodal analgesic regime. The primary endpoint was pain during walking 24 h after surgery, and secondary endpoints were pain at rest, pain upon hip flexion, and pain upon knee flexion. Pain assessments were performed repeatedly for the first 48 h after surgery, in a questionnaire from days 2 to 10, and at follow-up on days 21 and 30. Tertiary endpoints were postoperative nausea and vomiting (PONV), plasma C-reactive protein (CRP) concentrations, fatigue, sleep quality, and rescue analgesic and antiemetic requirements.ResultsPain during walking was significantly lower in the MP group up to 32 h after operation. Overall pain and cumulative pain scores (248 h) were lower for all pain assessments (P<0.04). Consumption of rescue oxycodone was lower from 0 to 24 h (P0.02) and PONV, consumption of ondansetron reduced (P<0.05), and CRP concentrations were lower at 24 h (P<0.000001). Fatigue throughout the day of surgery was lower (P0.02), but sleep quality was worse on the first night (P0.002). No side-effects or complications were observed in other respects.ConclusionsMP 125 mg before surgery improves analgesia and immediate recovery after TKA, even when combined with a multimodal analgesic regime. These findings call for further studies on safety aspects.

U2 - http://dx.doi.org/10.1093/bja/aeq333

DO - http://dx.doi.org/10.1093/bja/aeq333

M3 - Journal article

SN - 0007-0912

VL - 106

SP - 230

EP - 238

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 2

ER -

Effect of high-dose preoperative methylprednisolone on pain and recovery after total knee arthroplasty: a randomized, placebo-controlled trial

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